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26 August 2012

I thought I'd have a bit of fun and think about which famous people I would be fascinated to work with. It was difficult to keep the list to 5. To make life easier, I decided that the fantasy would be slightly less fantastical if I restricted it to the living. I considered The Dalai Lama, Irvin Yalom, Will Self and many others before settling on these. Maybe I should send my leaflet?

Seriously though, to make it clear, it is my belief that the best people for me to work with, are those that a) want to do the work, and b) have made an informed choice in choosing their counsellor and that feel comfortable with the counsellor and their approach.

I have included the Myers-Briggs Type Indictor for each person, and if you click you'll find a description of their personality type based upon the Myers-Briggs system.

I think he would be very entertaining, and the acerbic wit and highly intelligent banter could be difficult to penetrate. But underneath I reckon there is a complex soul. I would relish the challenge of accessing his vulnerability, which he lets slip through in his comedic roles.

His humour is often outrageous - pushing the boundaries of acceptable taste. My nearest and dearest may attest, my humourous side can be somewhat edgy at times. If I couldn't have a professional therapeutic relationship, I would be tempted to have a bad-taste-a-thon with this gentleman.

Well the press tells us that Christian has anger management issues, and I do enjoy working through anger with clients. I think that Christian can come across as aloof and I would be intrigued to see what impression I would get face to face, one-to-one. Christian is incredibly dedicated to his roles so I think that if he wanted therapy he would dedicate himself intensively to the work. He would probably push me to give him homework but at least he would turn up reliably to the sessions, possibly twice a week or more.

Christian also has a compassionate side, being a member of GreenPeace and the World Wildlife Fund and I'd like to see more of that.

I see Alain de Botton as a highly complex individual who is so academically clever and philosophical that this could potentially interfere with his being able to integrate his emotional side. I might have to get out the sandtray to get him "out of his head". There is creativity there, and I love his writing. It would easy to be drawn into philosophical discussion with this brainbox and the challenge here, would Alain be up for therapy, would be to bring the work back to him, his feelings, his life, rather than the greater concerns of mankind.

I follow Alain on Twitter and he tweets regularly; usually little snippets of shared observations about how we, as humans act. I often think of his tweets more as self-disclosure and suspect that they say more about his thoughts than the thoughts of mankind. They do usually get me thinking though. http://twitter.com/alaindebotton

It would be fascinating if this 86 year old decided that life was too short and she'd like to live the rest of her life for herself rather than for the public. I absolutely love working with people over 70 - generally I have found that this age group have the attitude that they have little left to lose, with a "now-or-never" attitude and can shift quickly, despite there often being entrenched behaviour spanning several decades. It is very rewarding and heartwarming work.

How refreshing for The Queen if she were able to shed the shackles of royal responsibility and to say what she REALLY thinks. Having seen her Olympic appearance with James Bond I think that Lizzy (for surely she would not want to be referred to as HRM during therapy?) has a bit of a cheeky streak and would enjoy the space to express her authentic self.

What a fabulous actor, and having watched the breathtaking and heartbreaking Tyrannosaur, what a director. I am fascinated by actors generally, and the desire/ability to escape into another's consciousness (if they're really doing it properly).

Why I would really like to counsel Paddy, if he were indeed to be in the area and fancy a course of counselling sessions, would be because he must have lived a colourful life, given his inside knowledge of dark characters and the ugly side of humanity. I was torn between Paddy and Shane Meadows, a director who's films Paddy almost always stars in. They are both in-the-know about the underclass of the UK and the realities that remain beyond the comprehension of most of the bourgeois. His acting and directing reflects his knowledge of the essence of the struggle of humanity and the demons that he attempts to exorcise through his work.

I would love to hear others' fantasy client list. Please share!

Amanda Williamson is a professional counsellor working in private practice in Exeter, Devon.

24 August 2012

Heavy in both senses of the term

I was delighted to receive this for Christmas last year. As most that know me are aware (and many that don't) I am in danger of placing Irvin Yalom on a pedestal, for his books are awesome (truly awesome, not "quite-good-but-I'll-say-awesome-to-make-it-sound-more-cool-and-vibrant-awesome").

Strangely, in an about-face of my usual reading preferences, I actually prefer Irvin's fiction to his non-fiction (this book is non-fiction, by the way). Generally speaking, I struggle with most fiction and can only really enjoy that which is edgy, inventive and written in terms of the world being various shades of grey (no, not that "shades of grey" - pah!) rather than black and white. So my favourite choices are Chuck Palahniuk, Will Self, Jean-Paul Sartre, H G Wells and some obscure sci-fi (look up the sub-genre "Dying Earth").

In the case of Yalom, his fiction hits the spot, and being that it is mainly about the psychotherapy profession holds automatic intrigue for me. The fact that Irvin is hugely super-intelligent and insightful, as well as humble and generous of spirit helps matters.

During my integrative training I firmly settled on preferring a person-centred approach for counselling. I did my placement hours at a person-centred organisation. The whole while I was aware that there was an undercurrent of existential approach to my practice and I explored this to a point whilst in training. Around a year ago I had a dream about some "experts" analysing my counselling work (this is the only dream I have ever had about my work, by the way). They told me that my approach was more existential than all the counsellors who were calling themselves existential. This dream awoke me to the truth of my approach - more existential than I was caring to declare. I was reading Sartre's "Age of Reason" and holidaying in Paris at the time so maybe the existential vibes soaked into me irreversibly that night.

So, to the book. Prior to reading this I warmed up with Skills in Existential Counselling and Psychotherapy by Emmy Van Deurzen and Martin Adams. It was decent enough, but quite basic and better suited to people in training (to whom I heartily recommend it). So I was eager enough to move onto the much weightier tome that is Yalom's offering.

I absolutely loved reading it. Every night, in bed, I was happy to open the book and feel it's heavy mightiness aching my arms and pushing against my body (sounding a bit 50 Shades...).

An enticing introduction explains a little about the history and current context of the realm of existential therapy. Yalom states that :

"...it is my belief that the vast majority of experienced therapists, regardless of their adherence to some other ideological school, employ many of the existential insights I shall describe." Yalom acknowledges the reputation the approach has for being vague and indefinable and goes on to say that ..."the existential approach is a valuable, effective psychotherapeutic paradigm, as rational, as coherent, and as systematic as any other".

Thereafter, the book is split into four parts - each part covering one of the "givens" of human existence.

Part 1 - Death

Probably the most obvious one. I think most people have had the thought at some time in their life "Yikes, I'm going to die one day". This part explores reactions to this knowledge, starting off with childhood and then looks at differing coping mechanisms. The idea of there being The Ultimate Rescuer intrigued me.

I was quite spooked when I read a paragraph on the relationship between sex and death. This part in particular, on the desire to merge with another and the paradoxical desire to retain autonomy:

"The task of satisfying both needs - for separateness and autonomy and for protection and merger - and of facing the fear inherent in each, is a lifelong dialectic that govern one's inner world. It is a task that begins in the first months of life, when the child, who first is symbiotically merged with the mother...must, in order to develop a sense of identity, of wholeness and separateness, disengage and differentiate from the mother..."

This was exciting for me to read as, before my appointment earlier this year with Yalom, I had mooted this very point as something I wanted to ask him about, before I was aware that he had written about it some 32 years earlier:

Connection – what is the source of our yearning for connection? Conception is the product of union; being born is the ultimate divide. Is love a construct to attempt to gain the approximation of the togetherness of gestation? And is death, therefore, sweet relief from the inevitable lifelong pain and yearning?

I was so excited - no wonder I love reading his stuff - he articulates and puts forward the very contents of my meandering mind. How does he do that? (I know, I know, my position on the narcissism spectrum springs to mind). Actually, as a tangent, I recently looked up Yalom's Myers-Briggs type which is apparently the same as mine, my partner and some very close friends of mine. Maybe there's something in this MBTI. Alain de Botton, another of my declared heroes, is also the same type. However, so is Hitler...(keeping my feet firmly on the ground there; de-narcissifying perhaps).

So back to death. As with the entire book, references to fiction, philosophy and the words of other, eminent psychotherapists are woven throughout the text. I like this paragraph and Yalom's reference to Otto Rank:

"The attempt to escape from death anxiety is at the core of the neurotic conflict.... The neurotic life style is generated by a fear of death, but insofar as it limits one's ability to live spontaneously and creatively, the defense against death is itself a partial death. That is what Rank meant when he said that the neurotic refuses the loan of death to escape the debt of death by daily-partial self-destruction."

Heavy.

And yet, refreshing...

Yalom refers to the Stoics:

"Contemplate death if you would learn how to live"

and Santayana:

"The dark background which death supplies brings out the tender colours of life in all their purity."

Far from depressing and morbid (as death-talk is often accused of being) I find that exploring death in this way makes me feel more alive and more appreciative of my life force. I do appreciate that it's not everybody's cup of tea, however, and the differing strategies or constructs to deal with the harsh reality of death are covered at a satisfying depth.

Part 2 - Responsibility

This refers to the freedom we have to make choices about our life. When looked at fundamentally, this is actually more scary than it seems on the surface. Yalom kicks off with a quote from Sartre regarding responsibility - to be responsible is to be "the uncontested author of an event or thing". As it happens, one of my favourite quotes comes from Sartre "Freedom is what you do with what you've been given" - which I thinks honours the fact that there are some things that can't be changed, and acknowledges the fact that some things are our choice...(or are they...I drive myself round in circles with this one...) anyway, it pretty much works for me...

Yalom states that "For the patient who will not accept such responsibility, who persists in blaming others (who knows someone like that?) - either other individuals or other forces - for his or her dysphoria, no real therapy is possible."

I was interested to read a description of what can be so alluring to be a member of a cult-like organisation. Irvin describes the culture of est - Erhard Seminars Training which purports to be big on helping the members assume responsibility for their own lives. However, Yalom points out the high level of conformity required by members who were to volunteer their time. Yalom quotes a volunteer, a clinical psychologist who explains her tasks to arrange name tags in perfect parallel rows, pinning tablecloths in exactly the same, formal way (under supervision) with meticulous attention to detail. She describes being thanked by a superior for writing directions as leaving her "high for hours". There was also apparently only one way to clean the toilets and if a coffee cup was raised to clean underneath it, it had be placed back precisely where it was.

Yalom wryly observes:

"Doing things the right way. Cleaning toilets the est way. Replacing coffee table objects precisely...doing humour at "humour time", "High for hours" after being complimented for mapping the most efficient route to the bathroom. These words reflect an obvious satisfaction in the losing of one's freedom, in the joy of surrendering autonomy and donning the blinders of a beast of burden."

I am quite interested in cult mentality at the moment and am currently reading "Captive Hearts, Captive Minds - Freedom and Recovery from Cults and Abusive Relationships" (Madeleine Landau Tobias and Janja Lalich). Reading Yalom's chapter on responsibility helps me to understand why some people would rather hand their's over to a cult, a religion, an illness (labelling oneself an addict, for example) or even a prison warden.

I love this quote from Binswanger:

"The fact that our lives are determined by the forces of life is only one side of the truth; the other is that we determine these forces as our fate. Only the two sides together can take in the full problem of sanity and insanity."

And another Stoic quote - this time Epictetus:

"I must die. I must be imprisoned. I must suffer exile. But must I die groaning? Must I whine as well? Can anyone hinder me from going into exile with a smile? The master threatens to chain me: what say you? Chain me? My leg you will chain - yes, but not my will - no, not even Zeus can conquer that."

Although I do think of water boarding and electric shock torture and wonder if those are capable of removing a man's will...? Another discussion...

And so onto...

Part 3 - Isolation

In a shorter section, Existential Isolation is explained. This is not lack of friends, or feeling "lonely" in the usual sense, which is interpersonal isolation. Nor is it intrapersonal isolation which Yalom describes as "whenever one stifle's one's own feelings or desires, accepts "oughts" or "should" as one's own wishes, distrusts one's own judgement, or buries one's potential". (*gulp*, been there, I can feel my existential guilt coming on...).

Existential isolation refers the gritty realisation that there will always be a gulf between us and another being, and, moreover, between us and the rest of the whole world (universe - EVERYTHING!).

Yalom writes a lot about relationship here and there is an analysis of Buber's contribution to the philosophy of relationship. Including this haunting dream which Buber writes about in his book "Between Man and Man":

whilst "in a vast cave, or mud building, or on the fringes of a gigantic forest.... I cry out....Each time it is the same cry, inarticulate but in strict rhythm, rising and falling, swelling to a fullness, which my throat could not endure were I awake, long and slow quite slow and very long, a cry that is a song. When it ends my heart stops beating. But then, somewhere, far away, another cry mourns towards me, another which is the same, the same cry uttered or sung by another voice"

Yalom moves on to Maslow who describes two types of love; one motivated by deficiency (selfish love) and the other by growth (unselfish love). Then comes Fromm's answer to the fundamental concern of existential isolation "The full answer lies in the achievement of interpersonal union, of fusion with another person, in love."

Ah! How romantic.

I could go a bit 50's shades here and describe Fromm's "symbiotic union" which consist of "an active (sadism) and a passive (masochism) form... a state of fusion where neither party is whole or free" but let's not. Let's look at "Mature love...a union under the condition of preserving one's integrity, one's individuality...In love the paradox occurs that two beings become one and remain two".

Which reminds me of how much I value Yalom's drawing upon centuries of philosophical and psychotherapeutic endeavour and presenting it, along with his own wisdom, throughout all of this work.

And so on to the final part...

Part 4 Meaninglessness

I struggle a little with the title as it implies (to me) that there is actually no meaning, although I do tend to see existence that way, personally. However, I appreciate that some people do believe that life has meaning for everybody. I'm not one of them. I believe that we create meaning for ourselves in order to make life easier. Enough of me.

Yalom starts off with a rather sombre suicide note (and yes, all the given of human existence overlap, at times considerably, and Yalom has done a good job of keeping them separate and honouring the overlaps):

"Imagine a happy group of morons who are engaged in work. They are carrying bricks in an open field. As soon as they have stacked all the bricks at one end of the field, they proceed to transport them to the opposite end. This continues without stop and everyday of every year they are busy doing the same thing. One day one of the morons stops long enough to ask himself what he is doing. He wonders what purpose there is in carrying the bricks. And from that instant on he is not quite as content with his occupation as he had been before.

I am the moron who wonders why he is carrying the bricks."

So the final part looks at how we struggle with and attempt to come to terms with the fact that existence does not come with meaning automatically provided. Yalom looks at Viktor Frankl's contributions which I very much value. I do struggle a little with an element of Frankl's philosophy - that EVERYBODY has choices (am working my way through Frankl's The Doctor and the Soul). I don't believe that everybody has choice. I do believe that those that come for counselling have the capacity to choose, and in the context of a blogpost written from the perspective of a counsellor, I think it is important to say that. I do enjoy reading Viktor Frankl and highly recommend "Man's Search for Meaning" to just about anybody. Yalom explores Frankl's "Logotherapy" which is not very well heard of but I think is a relatively philosophically sound approach to psychotherapy, from what I've read. Logotherapy is a therapy based on man finding meaning in life.

There is a fascinating exploration of the clinical manifestations of meaninglessness with headings such as "Existential Vacuum and Existential Neurosis" and Crusadism, Nihilism, and Vegetativeness". I do enjoy looking at the concept of nihilism in particular (click on the word if you're unsure as to it's meaning, and want to potentially stumble down a rabbithole).

In summary

This is a marvellous book, not for everybody but certainly for any therapists and for the layman who wants to explore his or her own existential givens.

It took Yalom 10 years to write it, and I am so glad he perservered. Thank you for providing this gift to the world. I want my children to read it, I want my loved ones to read it.

Amanda Williamson is a professional, private counsellor working in Exeter, Devon

This post is written from a purely anecdotal and personal point of view. I am aware that depression can be a medical illness and any action taken should be in conjunction with the expert advice of a GP.

I am writing about my perspective on the concept of depression. Many people are diagnosed each year with clinical depression. Between 8 and 12% of the population experience depression in any one year (1). So I see a lot of it in the counselling room - those that have been diagnosed and those that haven't been diagnosed but that seem to be exhibiting similar responses.

I attended a workshop a year or so ago about Hidden Losses - there was discussion about the stepping stone emotions as a reaction to loss. One of the emotional stages was depression and this seemed to spark some debate in the room of person-centred counsellors. Some seemed positively horrified at what they see as an unhealthy "label" and I was surprised at the strong reactions of some to the very notion that when we suffer loss, that a certain amount of depression is likely, or at least possible. The thing is, depression is as natural and likely as sadness, anger, shock and all the other emotional states associated with loss and as such, I do not see recognising this as unhelpful. In fact, I think that denying the existence of depression further stigmatises those that are depressed.

DEPRESSION IS A NATURAL RESPONSE TO CERTAIN ASPECTS OF LIVING

Life sometimes throws some pretty hefty challenges our way and we are not always in the best place to deal with them then and there. We will suffer loss at some stage of our lives. Fact. We will have misfortune of differing size and shapes (such as relationship conflict, job loss, illness, financial concerns). Fact. We may also be exposed to the grittier fundamental realities of life (our lives are finite, the realisation that we are responsible for our own lives, fears that life has no intrinsic meaning). These things can shake us to our very core and sometimes, depression may be an inevitable response to dealing with these issues, until we are in a position to take action to work on them, or to work through the process of coming to terms with them (acceptance - the final stepping stone of the loss process).

This can be fairly straightforward to deal with, and the client can use the counselling relationship to work through the emotional impact of the loss/change in their life. NB change always involves loss - even if the loss is of something deemed a negative influence on our life. We can be attached to negative emotional states and even with the desire to make that change it can come with some discomfort. Somehow, getting in touch with and honouring the very real emotional reaction can create a shift which helps alleviate or lift the depression.

DEPRESSION CAN BE A PROTECTIVE, SELF-DEFENCE MECHANISM

Strong feelings such as shock, sadness and anger are physically taxing on the body. Our bodies are flooded with peptides associated with each emotional state. Imagine how you feel when you feel overjoyed, or angry, or afraid. We feel these emotions in different parts of our bodies. See this picture, a result of research done by Orlagh O'Brien asking people to sketch where they feel emotions:

These feelings can be so strong, and physiologically very stressful. If we are in the midst of a life-crisis then depression may be our body's way of protecting ourselves from the harmful effects of such strong emoting, until we are ready and in a position to deal with the cause/s.

DEPRESSION CAN ALERT US TO THE FACT THAT WE ARE DOING SOMETHING WRONG

By this I mean that depression can be a natural response to the fact that we are living a life which is not in accordance with our real needs. From personal and professional experience I have witnessed that people can shift out of depression when they make change to their lives which mean they are doing things they want to do, rather than doing what they think they should do, or doing what others want them to do. The changes involved can be change of career, of relationship, or behavioural changes such as being able to prioritise one's needs as opposed to not even knowing what one's needs are.

Often, at the root of depression, is a lack of awareness of what one's own needs are. Helping people to get in touch with those needs is a privilege which I find so rewarding. I have had clients come back to me some time after therapy, delighted that they are now working in a field they really want to be working in, or that they have made relationship changes that means they are living a much more fulfilled life. This could be as simple as being able to share vulnerabilities and personal issues with friends, instead of continuing to be "the strong one". Sometimes counselling is a useful education in how to share vulnerabilities with others which leads to more meaningful relationships with others and the benefit of being heard.

One of the blockages to accessing and prioritising one's own needs can be a fundamental lack of acceptance, or unconditional positive regard towards the self. Many of my clients are absolutely selfless and so generous of heart and spirit to everybody but themselves. This may be a learned response from childhood, that their own needs don't matter, or that being in touch with their own needs has negative consequences. Sometimes, learning to access and honour those needs can create the shift required to help that person honour themselves and their requirements. This can be met with a fear that they will become too selfish. I point out that there is a spectrum of selfishness, with incredibly selfish and inconsiderate behaviour being at the far end, and that all they are looking at doing, is shifting along from the other end - of being completely selfless, towards the middle. A small change does not usually end up with the person leaping straight to the other end!

A WORD ON MEDICATION

I have worked with many people while they are taking anti-depressants. I was told by my supervisor when in training that it is a waste of time working with people on anti-depressants but with experience have come to disagree with this viewpoint. I believe that when depression gets so bad that someone is unable to function, then taking anti-depressants can help lift them enough to take action against what lead to the depression in the first place. However, anti-depressants do seem to affect people's ability to access their emotions freely, which may make the counselling process take longer. Ideally, going on anti-depressants should be a short-term solution with a plan in place, for the client to look at the underlying reasons for the depression, and to subsequently wean off the medication carefully.

Depression can be a sign of a physiological issue and as stated above, it is important that you seek medical advice if you are concerned that you may be suffering from depression.

(1)http://www.mentalhealth.org.uk/help-information/mental-health-statistics/common-mental-health-problems/?view=StandardAmanda Williamson is a professional, private counsellor working in Exeter, Devon.